Use of Video-Assisted Thoracic Surgery for Lobectomy in the Elderly Results in Fewer Complications

• Published in: The Annals of thoracic surgery Vol. 85; no. 1; pp. 231 - 236
• Main Authors: Cattaneo, Stephen M., MD, Park, Bernard J., MD, Wilton, Andrew S., MS, Seshan, Venkatraman E., PhD, Bains, Manjit S., MD, Downey, Robert J., MD, Flores, Raja M., MD, Rizk, Nabil, MD, Rusch, Valerie W., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2008
• Subjects: Age Factors; Aged; Aged, 80 and over; Cardiothoracic Surgery; Case-Control Studies; Female; Geriatric Assessment; Humans; Incidence; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Pneumonectomy - methods; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Probability; Prognosis; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery; Survival Analysis; Thoracic Surgery, Video-Assisted - methods; Thoracic Surgery, Video-Assisted - mortality; Thoracotomy - methods; Treatment Outcome; 10
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2007.07.080

Background The purpose of this study was to determine if the utilization of video-assisted thoracic surgery (VATS) for lobectomy for clinical stage I non-small cell lung cancer in elderly patients results in decreased complications compared with lobectomy by thoracotomy (THOR). Methods A retrospective, matched case-control study was performed evaluating the perioperative outcomes after lobectomy by VATS versus THOR performed in elderly patients (age ≥70 years) at a single institution. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 ( http://ctep.cancer.gov/reporting/ctc.html ). Results Between May 1, 2002 and December 31, 2005 333 patients (245 THOR, 88 VATS) 70 years old or greater underwent lobectomy for clinical stage I non-small cell lung cancer. After matching based on age, gender, presence of comorbid conditions, and preoperative clinical stage, there were 82 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications compared with THOR (28% vs 45%, p = 0.04) and a shorter median length of stay (5 days, range 2 to 20 vs 6 days, range 2 to 27, p < 0.001). No patients undergoing VATS lobectomy had higher than grade 2 complications, whereas 7% of complications in the THOR group were grade 3 or higher. There were no perioperative deaths in the VATS patients compared with an in-hospital mortality rate of 3.6% (3 of 82) for THOR patients. Conclusions A VATS approach to lobectomy for clinical stage I non-small cell lung cancer in the elderly was associated with fewer and overall reduced severity of complications as well as a shorter hospital stay compared with thoracotomy.